Lawsuit says nurse turned detective, lost job

By MARK HAYWARDNew Hampshire Union LeaderFebruary 14. 2013 11:21PMSuspecting that an anesthesiologist might be using narcotics intended for patients, a nurse did her own quick investigation, alerted Elliot Hospital officials about her suspicions and eventually lost her job, according to a recent lawsuit.

The nurse, Bedford resident Katherine K. Lacoste, switched syringes to test her suspicions that the anesthesiologist had mislabeled a syringe in order to divert a narcotic pain killer, according to a lawsuit on file at Hillsborough County Superior Court North.

Her fears proved correct, according to the lawsuit. The syringe, although labeled as such, did not contain the pain killer fentanyl. But months after Lacoste took those steps, she found herself peppered with questions from a panel of Elliot Hospital physicians and lawyers.

She was eventually told to resign or be fired; the employee of 12 years filed suit against her former employer in August 2012.

"Ms. Lacoste was shocked, saddened and stunned by this development, as she has always been exceedingly committed to conscientious and careful patient care," reads the lawsuit, filed by Concord lawyers Chuck Douglas and Stephen Duggan.

The incident touches on two of the biggest medical stories in New Hampshire during 2012.

The issue involves drug diversion - the problem that surfaced last year when Exeter Hospital discovered that one of its employees had been shooting up fentanyl and spreading hepatitis C to patients.

The anesthesiologist who fell under the nurse's suspicion - Dr. Brian Klagges - works at Amoskeag Anesthesia PLLC. Amoskeag Anesthesia is also the practice of Dr. Eduardo Quesada, the anesthesiologist and pain doctor who was brutally attacked at his Bedford home last November.

Police have yet to make an arrest in the case or give a clear explanation of what happened to Quesada.

Douglas stressed that Quesada is not part of the suit, but as the suit proceeds toward trial, his firm will seek information about Amoskeag Anesthesia.

"We would want to look at Amoskeag Anesthesia, and the people involved in the practice, to know what's going on there," he said Thursday.

Whistleblower?

Elliot Hospital issued a statement Thursday saying Lacoste's former employer was Amoskeag Anesthesia, and Elliot was not in a position to fire her. The hospital would not answer questions about an internal investigation involving Klagges.

"Elliot cannot comment on internal quality assurance activities, particularly in light of this pending litigation. However, Elliot has a robust, proactive and effective process for detecting, investigating, and addressing quality and safety issues," the statement said.

A message left with the business manager of Amoskeag Anesthesia was not returned Thursday.

Klagges is an anesthesiologist whose address is Elliot Hospital, according to his online licensing profile at the New Hampshire Board of Medicine. His license is scheduled to expire this June.

The lawsuit does not say Klagges abuses drugs, and Douglas said he's yet to receive information about Klagges as part of the discovery process.

In their responses to the suit, lawyers for Elliot and Amoskeag Anesthesia both said Lacoste does not have a case. The lawyers deny her claims, which include wrongful termination, retaliatory behavior, and violation of the state Whistleblower's Protection Act.

"Plaintiff (Lacoste) failed to first bring any alleged violation to the attention of persons having supervisory authority for defendant and allow defendant a reasonable opportunity to correct the violation," reads a response filed by David Wilson, the Boston lawyer hired by Amoskeag Anesthesia.

May 24, 2011

The lawsuit dwells on the actions of Lacoste and Klagges on May 24, 2011, when they were working together at Elliot at River's Edge. Four procedures of extracorporeal shock wave lithotripsy - a non-invasive treatment for kidney stones - were scheduled.

According to the lawsuit, the procedure requires the possible use of several drugs: Brevibloc, which is used to control heart rates and high blood pressure after surgery; the sedative Versed; the narcotic fentanyl.

The suit said that Lacoste's job involved making sure the drugs were on hand, getting them, tracking them in a computerized drug monitoring system, and charting their use.

The first three procedures were routine. However, when Lacoste went to fetch the fentanyl and Versed for the final procedure, the computer system said the fentanyl had already been taken out.

She took out the Versed. Klagges saw Lacoste and offered to help her get started. She gave him the Versed and said the fentanyl had already been taken out.

In the operating room, Lacoste became suspicious when she saw a cap missing from one of the three, purple-capped vials of Brevibloc. There was no reason for anyone but Lacoste to access the drugs.

She met with the patient in the pre-operative area, and something else was odd, according to the suit. The patient's companion said a doctor had come in and given him something to relax, which would have been Versed. But the surgeon had yet to speak to the patient, and normal practice is to sedate a patient after he has spoken with his surgeon.

"As the case unfolded, Ms. Lacoste was becoming increasingly uncomfortable," the lawsuit reads. "She was concerned that she might be witnessing a diversion of the controlled substance fentanyl by Dr. Klagges."

Before the procedure started, the patient was given the local anesthetic lidocaine, the sedative propofol and 1 milligram of fentanyl.

The fentanyl came from a syringe labeled fentanyl, but Lacoste knew she didn't label the syringe because the label was on a diagonal, and she is careful to label syringes straight up and down, the suit reads.

Klagges left the room and told Lacoste he would return in a few minutes to give her a lunch break.

"She immediately determined that, if she was going to be able to find out if the drug was being diverted, she only had approximately three minutes to remove the remaining fentanyl-labeled syringe for testing and replace it with one similarly labeled, as well as secure the patient's airway, administer general anesthesia, position the patient and monitor vital signs," the suit reads.

She took another syringe, and labeled it fentanyl, even placing the label askew. She filled it with 4 milligrams of Decadron, a post-operative anti-nausea drug that would not harm the patient if administered, the suit reads.

"Dr. Klagges arrived less than one minute after she put the suspicious fentanyl-labeled syringe from the induction into her pocket," the suit reads.

After that, Lacoste spoke to Rob Glew, the Elliot director of pharmacy, and gave him the syringe. The following day, Lacoste was told the syringe did not contain fentanyl.

Resign or be fired

Eighteen days later, Lacoste met with Elliot Vice President of Medical Affairs, Dr. Greg Baxter, who said the hospital was taking the matter very seriously. Then on June 15, she attended a meeting with four Elliot doctors, Glew and Elliot's in-house lawyer.

"The tone and tenure of the meeting was adversarial and tense at times," the suit reads. At one point, the lawyer, John Friberg, told the others to let Lacoste finish her answers, the suit reads.

In July, she was told to submit to a urine-drug test, and results were negative. The Elliot Peer Review Committee told her to attend a conflict resolution course and provided her with a channel for reporting suspicions in the future.

In the meantime, Amoskeag Anesthesia started to place complaints in her file. In late September 2011, she was offered the opportunity to resign or be terminated.

Amoskeag Anesthesia and Elliot reported her actions to the Board of Nursing, which dismissed the complaint, according to the suit.

"The Board acknowledged that Mrs. Lacoste was attempting to further patient safety by protecting a patient from possible drug diversion by a doctor, and there was no evidence of any intent to harm the patient in any way," the suit reads.

The case has been scheduled for trial in April 2014, but the sides have agreed to mediation.